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Mendonça BTVD, Machado V, Silva GG, Dias NM. Executive functions and functioning in women with fibromyalgia. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 39317225 DOI: 10.1055/s-0044-1790577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic condition characterized by widespread pain that is associated with sleep, emotional, and cognitive disturbances, including in executive functions (EFs). OBJECTIVE To investigate the relationship between EFs and functionality in women with FM. METHODS The study included 17 women with FM, aged between 30 and 59 years, with no history of neurological disease. The EFs were assessed using the Digit Span Subtest (DS), Five Digit Test, Trail Making Test (TMT), Corsi Block-Tapping Task, Hayling Test (HT), and Verbal Fluency Task. Functionality was evaluated through the Fibromyalgia Impact Questionnaire. The Beck Depression Inventory, Hamilton Anxiety Rating Scale, and Brief Pain Inventory were used to measure depression, anxiety, and pain, which were controlled in the statistical analyses. RESULTS The FM patients showed longer response latency on the HT and TMT. They made fewer errors on part B of the HT, and they performed worse on the DS backward and on the Corsi Block-Tapping Task forward and backward. There were moderate correlations in the expected direction between performance on the Corsi Block-Tapping Task backward and interference at work, as well as between the time to complete part B of the Trail Making Test - B (TMT-B) and fatigue. An unexpected relationship was found between errors on part B of the HT and interference at work. CONCLUSION The results suggest lower efficiency in processes such as inhibitory control and cognitive flexibility, difficulties in working memory and non-executive processes such as processing speed. Even with pain, anxiety, and depression controlled, some relationships between EFs and functionality were observed, indicating that these symptoms do not fully explain this relationship. We suggest that cognition, particularly EFs, and broader measures of functionality be considered in the evaluation of FM.
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Affiliation(s)
- Bárbara Thais Veras de Mendonça
- Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Departamento de Psicologia, Florianópolis SC, Brazil
| | - Valter Machado
- Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Departamento de Psicologia, Florianópolis SC, Brazil
| | - Guilherme Gomes Silva
- Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Departamento de Psicologia, Florianópolis SC, Brazil
| | - Natália Martins Dias
- Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Departamento de Psicologia, Florianópolis SC, Brazil
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Wilson JM, Meints SM, Edwards RR, Yamin JB, Moore DJ. The role of sleep disturbance in reduced accuracy on a divided attention task among patients with fibromyalgia. Pain Rep 2024; 9:e1. [PMID: 38229708 PMCID: PMC10789454 DOI: 10.1097/pr9.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/12/2023] [Accepted: 10/29/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction Patients with fibromyalgia show impaired cognitive performance compared with healthy, pain-free controls. Sleep disturbance, anxiety, and depression are highly prevalent among patients with fibromyalgia, and each is associated with impaired cognitive performance. Yet, limited work has explored whether psychosocial factors contribute to group differences in cognitive performance. Objectives This secondary data analysis investigated differences in cognitive performance between patients with fibromyalgia and healthy controls, and whether psychosocial factors accounted for these differences. Methods Adults with fibromyalgia (N = 24) and healthy, pain-free controls (N = 26) completed 2 cognitive tasks and the Patient-Reported Outcomes Measurement Information System sleep disturbance, anxiety, and depression short forms. Independent samples t tests were used to test for differences in cognitive performance between patients with fibromyalgia and healthy controls. Pearson correlations were conducted to examine associations between psychosocial factors and cognitive performance. Psychosocial factors significantly related to cognitive performance were explored as potential mediators of group differences in cognitive performance. Results Patients with fibromyalgia demonstrated poorer accuracy for divided attention compared with healthy controls, and sleep disturbance mediated this group difference. On the attentional switching task, healthy controls showed a greater switch-cost for accuracy compared with patients with fibromyalgia, but there was no group difference in reaction time. Anxiety and depression were not related to cognitive performance. Conclusion We found that patients with fibromyalgia reported greater sleep disturbance and, in turn, had poorer accuracy on the divided attention task. Sleep disturbance is modifiable with behavioral interventions, such as cognitive behavioral therapy, and may be a target for improving sleep quality and cognitive performance among patients with fibromyalgia.
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Affiliation(s)
- Jenna M. Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Samantha M. Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jolin B. Yamin
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David J. Moore
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, United Kingdom
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Valentine TR, Kratz AL. Feasibility, reliability, and validity of ambulatory cognitive tests in fibromyalgia and matched controls. J Int Neuropsychol Soc 2023; 29:893-901. [PMID: 36762635 PMCID: PMC10412734 DOI: 10.1017/s1355617723000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE This observational study examined the feasibility, reliability, and validity of repeated ambulatory cognitive tests in fibromyalgia (FM). METHOD Adults with FM (n = 50) and matched controls (n = 50) completed lab-based neuropsychological tests (NIH Toolbox) followed by eight days of smartphone-based ambulatory testing of processing speed (symbol search) and working memory (dot memory) five times daily. Feasibility was assessed based on response rates. Reliability was evaluated using overall average between-person reliabilities for the full assessment period and by determining the number of assessment days necessary to attain reliabilities of >.80 and >.90. To assess convergent validity, correlations were calculated between ambulatory test scores and NIH Toolbox scores. Test performance was contrasted between the FM and non-FM groups to examine known-groups validity. RESULTS Average rates of response to the ambulatory cognitive tests were 89.5% in FM and 90.0% in non-FM. Overall average between-person reliabilities were ≥.96. In FM, between-person reliability exceeded .90 after two days for symbol search and three days for dot memory. Symbol search scores correlated with NIH Toolbox processing speed scores in both groups, though there were no significant group differences in symbol search performance. Dot memory scores correlated with NIH Toolbox working memory scores in both groups. FM participants exhibited worse dot memory performance than did non-FM participants. CONCLUSIONS Repeated ambulatory tests of processing speed and working memory demonstrate feasibility and reliability in FM, though evidence for construct validity is mixed. The findings demonstrate promise for future research and clinical applications of this approach to assessing cognition in FM.
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Affiliation(s)
- Thomas R. Valentine
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Anna L. Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Schmidt J, Fritz M, Weisbrod M. Relevance of neurocognition in chronic pain syndrome: a systematic and methodical approach. J Clin Exp Neuropsychol 2023; 45:874-889. [PMID: 38406973 DOI: 10.1080/13803395.2024.2314732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/27/2023] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Subjective and objective deficits in neurocognitive domains are well-documented in patients with chronic pain. However, neurocognitive deficits have not been investigated consistently. The main objective of this study was to conduct a comprehensive assessment of self-rated and objectively assessed cognitive differences between patients with chronic pain (CP) and healthy controls (HC). METHOD The cognitive functioning of 40 CP and 41 HC was assessed using a standardized computer-based test battery, enabling a comparison of subjective and objective neurocognitive factors. To achieve this, the Vienna Test System (VTS) was utilized, incorporating standardized tests from the Cognitive Basic Assessment Battery (COGBAT) with the advantage of objectivity, reliability, validity, efficiency, utility, and standardization. This approach enables the evaluation of cognitive functioning across all pertinent domains. RESULTS CP reported cognitive deficits in overall performance as well as specific functions, such as attention, memory, and executive functions. Across all neurocognitive domains, CP showed a poorer performance. Affected subdomains of attention were intensity and selectivity of attention. Lower performance was found also in concentration performance, obtaining and overview, visual orientation performance and reactive stress tolerance. Regarding memory, CP performed worse in figural episodic memory and recognition tasks. In addition, CP exhibited poorer performance in mental flexibility, working memory, planning ability, and inhibition as components of executive functioning, when compared to HC. CONCLUSIONS CP expressed subjective cognitive deficits and demonstrated impaired neurocognitive performance.
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Affiliation(s)
- Janna Schmidt
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, Karlsbad, Germany
- Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, Karlsbad, Germany
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Fritz
- Department of Neurology, SRH Clinic Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Matthias Weisbrod
- Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, Karlsbad, Germany
- Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, Karlsbad, Germany
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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Kim S, Dowgwillo EA, Kratz AL. Emotional Dynamics in Fibromyalgia: Pain, Fatigue, and Stress Moderate Momentary Associations Between Positive and Negative Emotions. THE JOURNAL OF PAIN 2023; 24:1594-1603. [PMID: 37094743 PMCID: PMC10527274 DOI: 10.1016/j.jpain.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
Affective disruptions, particularly deficits in positive affect, are characteristic of fibromyalgia (FM). The Dynamic Model of Affect provides some explanations of affective disruptions in FM, suggesting that the inverse association between positive and negative emotions is stronger when individuals with FM are under greater stress than usual. However, our understanding of the types of stressors and negative emotions that contribute to these affective dynamics is limited. Using ecological momentary assessment (EMA) methods, 50 adults who met the FM survey diagnostic criteria rated their momentary pain, stress, fatigue, negative emotions (depression, anger, and anxiety), and positive emotions 5X/day for eight days using a smartphone application. Results of multilevel modeling indicate that, consistent with the Dynamic Model of Affect, there was a stronger inverse association between positive emotion and negative emotions during times of greater pain, stress, and fatigue. Importantly, this pattern was specific to depression and anger, and was not present for anxiety. These findings suggest that fluctuations in fatigue and stress may be just as important or more important than fluctuations in pain when understanding the emotional dynamics in FM. In addition, having a more nuanced understanding of the role that different negative emotions play may be similarly important to understanding emotional dynamics in FM. PERSPECTIVE: This article presents new findings on the emotional dynamics in FM during times of increased pain, fatigue, and stress. Findings highlight the need for clinicians to conduct a comprehensive evaluation of fatigue, stress, and anger in addition to more routinely assessed depression and pain when working with individuals with FM.
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Affiliation(s)
- Samsuk Kim
- Department of Psychology, University of Detroit Mercy, Detroit, MI
| | | | - Anna L. Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
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Kairys AE, Valentine TR, Whibley D, Kratz AL. Mind the Mood: Momentary Depression and Anxiety Moderate the Correspondence Between Subjective and Objective Cognitive Functioning in Fibromyalgia. Arthritis Care Res (Hoboken) 2023; 75:1967-1975. [PMID: 36601904 PMCID: PMC10319918 DOI: 10.1002/acr.25086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Subjective cognitive dysfunction (SCD) affects 55-75% of individuals with fibromyalgia (FM), but those reporting cognitive difficulties often lack corresponding objective deficits. Symptoms of depression and anxiety are prevalent in FM and may account for part of this discrepancy. This study was undertaken to investigate whether momentary (within-day, across 7 days) changes in mood moderate the relationship between within-the-moment SCD and mental processing speed performance. METHODS A total of 50 individuals with FM (mean age 44.8 years, mean education 15.7 years, 88% female, 86% White) completed momentary assessments of subjective cognitive functioning, depressive and anxious symptoms, and a test of processing speed. Assessments were completed 5 times per day for 8 consecutive days on a study-specific smartphone application. RESULTS Momentary ratings of SCD were positively associated with mean reaction time (P < 0.001) and variability of processing speed (P = 0.02). Depressive symptoms moderated the relationship between SCD and processing speed, with lower correspondence when depressive symptoms were higher (P = 0.03). A similar moderating effect was demonstrated for both depression (P = 0.02) and anxiety (P = 0.03) on the association between SCD and variability in processing speed performance. CONCLUSION Individuals with FM may have more accurate self-perception of momentary changes in mental processing speed during periods of less pronounced mood symptoms based on their corresponding objective processing speed performance. However, during moments of heightened depression and anxiety, we found increasingly less correspondence between SCD and objective performance, suggesting that psychological symptoms may play an important role in self-perception of cognitive dysfunction in FM as it relates to mental processing speed.
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Pinto AM, Luís M, Geenen R, Palavra F, Lumley MA, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, Häuser W, Kosek E, López-Solà M, Mease P, Marques TR, Jacobs JWG, Castilho P, da Silva JAP. Neurophysiological and Psychosocial Mechanisms of Fibromyalgia: A Comprehensive Review and Call for An Integrative Model. Neurosci Biobehav Rev 2023:105235. [PMID: 37207842 DOI: 10.1016/j.neubiorev.2023.105235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023]
Abstract
Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fibromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the understanding, assessment, and intervention for fibromyalgia.
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Affiliation(s)
- Ana Margarida Pinto
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal; University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal.
| | - Mariana Luís
- Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal.
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Martinus J. Langeveldgebouw, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, the Netherlands.
| | - Filipe Palavra
- Centre for Child Development, Neuropediatric Unit. Pediatric Hospital, Coimbra Hospital and University Centre, Avenida Afonso Romão, 3000-602 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7908, Detroit, MI 48202, USA.
| | - Jacob N Ablin
- Internal Medicine H, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
| | - Kirstine Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Jaime Branco
- Rheumatology Department, Egas Moniz Hospital - Lisboa Ocidental Hospital Centre (CHLO-EPE), R. da Junqueira 126, 1349-019 Lisbon, Portugal; Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal.
| | - Dan Buskila
- Ben Gurion University of the Negev Beer-Sheba, Israel.
| | - João Castelhano
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, Department of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec, Canada, H3G 1A4.
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm 171 77, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA.
| | - Tiago Reis Marques
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, South Kensington, London SW7 2BU, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London WC2R 2LS, UK.
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
| | - Paula Castilho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal.
| | - José A P da Silva
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
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Kazim MA, Strahl A, Moritz S, Arlt S, Niemeier A. Chronic pain in osteoarthritis of the hip is associated with selective cognitive impairment. Arch Orthop Trauma Surg 2023; 143:2189-2197. [PMID: 35511355 PMCID: PMC10030427 DOI: 10.1007/s00402-022-04445-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/10/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Chronic pain of various origin is known to be associated with selective cognitive impairment. Osteoarthritis (OA) of the hip is one of the leading causes of chronic pain in the adult population, but its association with cognitive performance has not been evaluated. Here, we investigate the effect of chronic pain due to unilateral OA of one hip and no further source of chronic pain on cognitive performance. MATERIALS AND METHODS A neuropsychological test battery, consisting of the Mini-Mental State Examination, Rey-Osterrieth complex figure test, Rivermead behavioural memory test, d2 test of attention, and F-A-S test was applied in 148 patients and 82 healthy pain-free control individuals. The influence of potentially confounding factors such as depression and anxiety was examined. RESULTS Patients with OA of the hip showed decreased performance in specific neuropsychological tests. Performance in verbal and visual short-term and long-term memory and selective attention tests was significantly poorer compared to healthy controls. Whereas the executive functions "updating", "set shifting", "response inhibition" and "reflection" appear intact, "problem solving" and "planning" were impaired. None of the confounders showed any influence on cognitive performance in both study groups. CONCLUSION We conclude that chronic pain secondary to end-stage hip OA is associated with selective cognitive impairment. Future studies are required to investigate the effect of total hip arthroplasty on cognitive performance.
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Affiliation(s)
- Murteza Ali Kazim
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - André Strahl
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Andreas Niemeier
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
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Ferrera D, Gómez-Esquer F, Peláez I, Barjola P, Fernandes-Magalhaes R, Carpio A, De Lahoz ME, Martín-Buro MC, Mercado F. Working memory dysfunction in fibromyalgia is associated with genotypes of the catechol- O-methyltransferase gene: an event-related potential study. Eur Arch Psychiatry Clin Neurosci 2023; 273:25-40. [PMID: 36100778 PMCID: PMC9958168 DOI: 10.1007/s00406-022-01488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
Recent findings have associated different COMT genotypes with working memory capacity in patients with fibromyalgia. Although it is thought that the COMT gene may influence neural correlates (P2 and P3 ERP components) underlying working memory impairment in this chronic-pain syndrome, it has not yet been explored. Therefore, the aim of the present research was to investigate the potential effect of the COMT gene in fibromyalgia patients on ERP working memory indices (P2 and P3 components). For this purpose, 102 participants (51 patients and 51 healthy control participants) took part in the experiment. Event-related potentials and behavioral responses were recorded while participants performed a spatial n-back task. Participants had to decide if the stimulus coincided or not in the same location as the one presented one (1-back condition) or two (2-back condition) trials before. Genotypes of the COMT gene were determined through a saliva sample from all participants. Present results significantly showed lower working memory performance (p < 0.05) in patients with fibromyalgia as compared to control participants (higher rate of errors and slower reaction times). At neural level, we found that patients exhibited enhanced frontocentral and parieto-occipital P2 amplitudes compared to control participants (p < 0.05). Interestingly, we also observed that only fibromyalgia patients carrying the Val/Val genotype of the COMT gene showed higher frontocentral P2 amplitudes than control participants (p < 0.05). Current results (behavioral outcomes and P2 amplitudes) confirmed the presence of an alteration in working memory functioning in fibromyalgia. The enhancement of frontocentral P2 could be reflecting that these patients would manifest an inefficient way of activating executive attention processes, in carriers of the Val/Val genotype of COMT. To our knowledge, the present findings are the first linking neural indices of working memory dysfunctions and COMT genotypes in fibromyalgia. Applying a subgroup of patient's strategy based on this genetic marker could be useful to establish more tailored therapeutical approaches.
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Affiliation(s)
- David Ferrera
- grid.28479.300000 0001 2206 5938Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Av. Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Francisco Gómez-Esquer
- grid.28479.300000 0001 2206 5938Emerging Research Group of Anatomical, Molecular and Human Development Bases, Department of Basic Health Sciences, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Irene Peláez
- grid.28479.300000 0001 2206 5938Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Av. Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Paloma Barjola
- grid.28479.300000 0001 2206 5938Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Av. Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Roberto Fernandes-Magalhaes
- grid.28479.300000 0001 2206 5938Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Av. Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Alberto Carpio
- grid.28479.300000 0001 2206 5938Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Av. Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - María Eugenia De Lahoz
- grid.28479.300000 0001 2206 5938Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Av. Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - María Carmen Martín-Buro
- grid.28479.300000 0001 2206 5938Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Av. Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Francisco Mercado
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Av. Atenas s/n. 28922, Alcorcón, Madrid, Spain.
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MELCHIOR MDO, ANTUNES LG, BATAGLION C, MAGRI LV. Can high pain intensity and catastrophizing interfere with the cognitive performance of women with chronic pain related TMD? A cross-sectional study. J Appl Oral Sci 2023; 31:e20220384. [PMID: 36995880 PMCID: PMC10065759 DOI: 10.1590/1678-7757-2022-0384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/16/2022] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Interventions based on pain education and self-management are dependent on factors such as attention, memory, concentration, and executive function. To explore the relationship between cognitive performance and the variables pain intensity, central sensitization, catastrophizing, and hypervigilance in women diagnosed with chronic pain-related TMD. METHODOLOGY This is a cross-sectional study. A total of 33 women (mean age: 38±4.6 years; range: 18 to 66 years) with chronic pain-related TMD (myalgia and/or arthralgia) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Specific questionnaires were used to evaluate cognitive performance, overall pain intensity, central sensitization, hypervigilance, and pain catastrophizing. The data were analyzed using Pearson's correlation coefficient and backward stepwise multiple linear regression (statistical significance at 5% alpha). RESULTS Approximately 53% of the study sample showed decreased cognitive performance. High central sensitization, hypervigilance, and pain catastrophizing were observed. A significant negative correlation was observed between cognitive performance and hypervigilance (p=.003, r=-.49), cognitive performance and catastrophizing (p<.001, r=-.58), and cognitive performance and pain intensity (p<.001, r=-.58). Regarding the partial regression coefficients, only catastrophizing and pain intensity showed statistical significance (t=-2.12, p=.043; t=-2.64, p=.014, respectively), indicating a significant role in explaining cognitive performance at the sample. CONCLUSION High pain intensity and the presence of catastrophic thoughts regarding pain can predict impaired cognitive performance in women with chronic pain-related TMD. Management strategies addressing psychosocial dimensions such as reducing catastrophizing and ensuring complete understanding of the condition are important.
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Jotwani ML, Wu Z, Lunde CE, Sieberg CB. The missing mechanistic link: Improving behavioral treatment efficacy for pediatric chronic pain. FRONTIERS IN PAIN RESEARCH 2022; 3:1022699. [PMID: 36313218 PMCID: PMC9614027 DOI: 10.3389/fpain.2022.1022699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Pediatric chronic pain is a significant global issue, with biopsychosocial factors contributing to the complexity of the condition. Studies have explored behavioral treatments for pediatric chronic pain, but these treatments have mixed efficacy for improving functional and psychological outcomes. Furthermore, the literature lacks an understanding of the biobehavioral mechanisms contributing to pediatric chronic pain treatment response. In this mini review, we focus on how neuroimaging has been used to identify biobehavioral mechanisms of different conditions and how this modality can be used in mechanistic clinical trials to identify markers of treatment response for pediatric chronic pain. We propose that mechanistic clinical trials, utilizing neuroimaging, are warranted to investigate how to optimize the efficacy of behavioral treatments for pediatric chronic pain patients across pain types and ages.
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Affiliation(s)
- Maya L. Jotwani
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Ziyan Wu
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Claire E. Lunde
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Christine B. Sieberg
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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12
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Neurocognitive Outcome Following Recovery from Severe Acute Respiratory Syndrome - Coronavirus-1 (SARS-CoV-1). J Int Neuropsychol Soc 2022; 28:891-901. [PMID: 34488921 DOI: 10.1017/s1355617721001107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Severe acute respiratory syndrome (SARS) is a highly contagious viral respiratory illness associated with hypoxia and dyspnea. Many of those who contracted and recovered from SARS during the 2002-2003 outbreak reported persistent physical, psychological, and cognitive difficulties. Here, we investigated the residual influences of SARS on cognition for a subset of healthcare professionals who recovered and were referred for neuropsychological evaluation through their workplace insurance. METHOD Twenty-eight healthcare professionals were evaluated on neuropsychological and mood functioning approximately 1.5 years post-recovery from a severe respiratory illness. Test scores were compared with age-matched normative data, and correlations were examined between mood, self-report memory scales, subjective complaints (e.g., poor concentration, pain, fatigue), illness severity (i.e., length of hospitalization, oxygen use during hospital stay), and cognitive performance. RESULTS Participants performed within age expectations on the majority of cognitive measures including overall memory ability. Although processing speed was generally within normal limits, 43% showed significant speed-accuracy trade-offs favoring accuracy over maintaining speed. Deficits were observed on measures of complex attention, such as working memory and the ability to sustain attention under conditions of distraction. Participants endorsed poorer memory ability than same-age peers on a meta-memory measure and mild to moderate depression and anxiety symptoms. Objective test performance was largely uncorrelated with self-reports, mood, or illness severity, except for moderate correlations between complex attention and participants' subjective ratings of Everyday Task-Oriented Memory. CONCLUSIONS These findings demonstrate specific long-term cognitive deficits associated with SARS and provide further evidence of the cognitive effects of hypoxic illnesses.
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13
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Schmidt J, Weisbrod M, Fritz M, Aschenbrenner S. Kognition und Kraftfahreignung bei chronischem Schmerzsyndrom. DER NERVENARZT 2022; 94:335-343. [PMID: 36169672 PMCID: PMC10104908 DOI: 10.1007/s00115-022-01387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 10/14/2022]
Abstract
ZusammenfassungKognitive Auffälligkeiten bei Patienten mit chronischen Schmerzen finden in wissenschaftlichen Untersuchungen zunehmend Beachtung. Die Folgen dieser kognitiven Störungen in Bezug auf die Schmerzbewältigung, die Alltagsgestaltung und die Kraftfahreignung werden in der klinischen Praxis jedoch kaum berücksichtigt, obwohl die Hälfte aller Patienten davon betroffen ist. Die vorliegende Arbeit fasst die aktuelle Studienlage zusammen und diskutiert Möglichkeiten der Integration in die klinische und therapeutische Versorgung.
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Affiliation(s)
- J Schmidt
- Abteilung für Klinische Psychologie und Neuropsychologie, SRH Klinikum Karlsbad, Guttmannstr. 1, 76307, Karlsbad-Langensteinbach, Deutschland.
- Medizinische Fakultät Heidelberg der Universität Heidelberg, Heidelberg, Deutschland.
| | - M Weisbrod
- Abteilung für Psychiatrie und Psychotherapie, SRH Klinikum Karlsbad, Karlsbad-Langensteinbach, Deutschland
- Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Fritz
- Abteilung für Neurologie, SRH Klinikum Karlsbad, Karlsbad-Langensteinbach, Deutschland
| | - S Aschenbrenner
- Abteilung für Klinische Psychologie und Neuropsychologie, SRH Klinikum Karlsbad, Guttmannstr. 1, 76307, Karlsbad-Langensteinbach, Deutschland
- Abteilung für Psychiatrie und Psychotherapie, SRH Klinikum Karlsbad, Karlsbad-Langensteinbach, Deutschland
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14
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Cedres N, Aejmelaeus-Lindström A, Ekström I, Nordin S, Li X, Persson J, Olofsson JK. Subjective Impairments in Olfaction and Cognition Predict Dissociated Behavioral Outcomes. J Gerontol B Psychol Sci Soc Sci 2022; 78:1-9. [PMID: 36000774 PMCID: PMC9890914 DOI: 10.1093/geronb/gbac124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Self-rated subjective cognitive decline (SCD) and subjective olfactory impairment (SOI) are associated with objective cognitive decline and dementia. However, their relationship and co-occurrence is unknown. We aimed to (a) describe the occurrence of SOI, SCD and their overlap in the general population; (b) compare SOI and SCD in terms of longitudinal associations with corresponding objective olfactory and cognitive measures; and (c) describe how SOI and SCD may lead to distinct sensory and cognitive outcomes. METHODS Cognitively unimpaired individuals from the third wave of the Swedish population-based Betula study (n = 784, aged 35-90 years; 51% females) were split into self-rated SOI, SCD, overlapping SCD + SOI, and controls. Between-subject and within-subject repeated-measures MANCOVA were used to compare the groups regarding odor identification, cognition, age, sex, and education. Spearman correlation was used to assess the different patterns of association between olfaction and cognition across groups. RESULTS SOI was present in 21.1%, whereas SCD was present in 9.9% of participants. According to a chi-square analysis, the SCD + SOI overlap (2.7%) is on a level that could be expected if the phenomena were independent. Odor identification in SOI showed decline at the 10-year follow-up (n = 284) and was positively associated with cognition. The SOI and SCD groups showed distinct cognitive-olfactory profiles at follow-up. CONCLUSIONS SOI occur independently of SCD in the population, and these risk factors are associated with different cognitive and olfactory outcomes. The biological causes underlying SOI and SCD, as well as the risk for future cognitive impairment, need further investigation.
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Affiliation(s)
- Nira Cedres
- Address correspondence to: Nira Cedres, PhD, Department of Psychology, Sensory Cognitive Interaction Laboratory (SCI-Lab), Stockholm University, Albanovägen 12, 114 19 Stockholm, Sweden. E-mail:
| | - Andrea Aejmelaeus-Lindström
- Department of Psychology, Sensory Cognitive Interaction Laboratory (SCI-Lab), Stockholm University, Stockholm, Sweden
| | - Ingrid Ekström
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Xin Li
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Persson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jonas K Olofsson
- Department of Psychology, Sensory Cognitive Interaction Laboratory (SCI-Lab), Stockholm University, Stockholm, Sweden
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15
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Crowley S, Mickle AM, Wiggins ME, Cardoso J, Lai S, Tanner JJ, Staud R, Fillingim RB, Price CC, Sibille KT. Relationships Between Cognitive Screening Composite Scores and Pain Intensity and Pain Disability in Adults With/At Risk for Knee Osteoarthritis. Clin J Pain 2022; 38:470-475. [PMID: 35514280 PMCID: PMC9210870 DOI: 10.1097/ajp.0000000000001042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 04/27/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Chronic pain, cognitive deficits, and pain-related disability are interrelated. The prevalence of chronic pain and undiagnosed cognitive difficulties in middle age and older adults is increasing. Of the cognitive systems, executive function and episodic memory are most relevant to chronic pain. We examined the hypothesis that cognitive screening composite scores for executive function and memory would negatively associate with pain intensity and pain disability in a group of middle-aged and older adults with knee pain with or at risk for osteoarthritis. METHODS A total of 120 adults (44 men/76 women), an average age of 59 years, participated in the study. Demographic, health history, clinical pain, and cognitive measures were completed. Relationships between pain intensity, pain disability, and the Montreal Cognitive Assessment (MoCA) total and composite scores were examined with relevant covariates in the model. RESULTS MoCA raw scores ranged from 13 to 30 with a mean score of 23.9. Pain intensity was negatively associated with overall MoCA total and executive function and memory composite scores. Pain disability over the previous 6 months was negatively associated with executive function, while pain disability over the past 48 hours was not associated with executive function. CONCLUSION The results of the current study demonstrates associations between pain metrics and cognitive domain scores within a common cognitive screening tool.
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Affiliation(s)
- Sam Crowley
- Departments of Clinical and Health Psychology
| | | | - Margaret E Wiggins
- Departments of Clinical and Health Psychology
- Perioperative Cognitive Anesthesia Network
| | | | - Song Lai
- Department of Radiation Oncology & CTSI Human Imaging Core, University of Florida, Gainesville, FL
| | - Jared J Tanner
- Departments of Clinical and Health Psychology
- Perioperative Cognitive Anesthesia Network
| | | | | | - Catherine C Price
- Departments of Clinical and Health Psychology
- Anesthesiology
- Perioperative Cognitive Anesthesia Network
| | - Kimberly T Sibille
- Anesthesiology
- Physical Medicine and Rehabilitaton
- Pain Research Center of Excellence
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16
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Muñoz Ladrón de Guevara C, Reyes del Paso GA, Fernández Serrano MJ, Montoro CI. Fibromyalgia Syndrome and Cognitive Decline: The Role of Body Mass Index and Clinical Symptoms. J Clin Med 2022; 11:3404. [PMID: 35743474 PMCID: PMC9224759 DOI: 10.3390/jcm11123404] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 01/27/2023] Open
Abstract
The high prevalence of obesity and overweight in fibromyalgia (FM) may be an important factor in the well-known cognitive deficits seen in the disorder. This study analyzed the influence of body mass index (BMI) and primary clinical symptoms of FM (pain, fatigue, insomnia, anxiety, and depression) on attention, memory, and processing speed in FM. Fifty-two FM patients and thirty-two healthy participants completed cognitive tasks assessing selective, sustained, and divided attention; visuospatial and verbal memory; and information processing speed. Furthermore, they were evaluated in terms of the main clinical symptoms of the disorder. FM patients showed a marked reduction of cognitive performance in terms of selective, sustained, and divided attention; visuospatial memory; and processing speed, but no group differences were observed in verbal memory. BMI negatively affects sustained and selective attention, verbal memory, and processing speed and is the main predictor of performance in these basic cognitive domains. Our findings confirm the presence of cognitive deficits with respect to attention and visual memory, as well as slower processing speed, in FM. Moreover, the results support a role of BMI in the observed cognitive deficits. Interventions increasing physical activity and promoting cognitive stimulation could be useful for strengthening cognitive function in FM patients.
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17
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Alvarez MC, Albuquerque MLL, Neiva HP, Cid L, Rodrigues F, Teixeira DS, Matos R, Antunes R, Morales-Sánchez V, Monteiro D. Exploring the Relationship between Fibromyalgia-Related Fatigue, Physical Activity, and Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084870. [PMID: 35457737 PMCID: PMC9032824 DOI: 10.3390/ijerph19084870] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 12/28/2022]
Abstract
The symptoms of fibromyalgia are varied, including general muscle pain and pain at specific points (also called tender points), excessive fatigue, anxiety, depression, and some psychological problems that can have a negative impact on quality of life. Physical activity is a widely used option by health professionals to alleviate the effects of this syndrome. However, there is no clear information on the possible mediating role of physical activity in the relationship between fibromyalgia-related fatigue and quality of life. Therefore, this study aims to evaluate the relationship between fibromyalgia-related fatigue and quality of life, and to investigate the mediating role of physical activity in patients with this syndrome. Methods: In a cross-sectional study, 237 Portuguese women aged 28 to 75 years (M = 49.12; SD ± 8.87) and 117 Brazilian women aged 20 to 69 years (M = 46.72; SD ± 8.38) were recruited to participate in this study. These patients completed three valid and reliable questionnaires related to the assessment of fibromyalgia-related fatigue (MDF-Fibro-17), physical activity (IPAQ), and quality of life (SF-36). Results: Both samples had scores above the midpoint for all dimensions of fibromyalgia-related fatigue and scores below the midpoint for quality of life. Physical activity had no mediating effect in either sample, as the total indirect effect was not significant. Conclusions: Physical activity does not mediate the relationship between fatigue and quality of life. However, the results also show that the fatigue dimensions associated with fibromyalgia had a negative and significant association with physical and mental health indicators in both samples. Thus, patients with FM with higher scores on fatigue-related symptoms might suffer more from physical and mental health, both of which are related to quality of life.
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Affiliation(s)
- Marcos C. Alvarez
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (M.C.A.); (M.L.L.A.); (H.P.N.)
| | - Maria Luiza L. Albuquerque
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (M.C.A.); (M.L.L.A.); (H.P.N.)
| | - Henrique P. Neiva
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (M.C.A.); (M.L.L.A.); (H.P.N.)
- Research Center in Sport, Health and Human Development (CIDESD), Trás os Montes and Alto Douro University, 5000-558 Vila Real, Portugal;
| | - Luis Cid
- Research Center in Sport, Health and Human Development (CIDESD), Trás os Montes and Alto Douro University, 5000-558 Vila Real, Portugal;
- Sport Sciences School of Rio Maior, Polytechnic of Santarém (ESDRM-IPSantarém), 2040-413 Rio Maior, Portugal
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
| | - Filipe Rodrigues
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Diogo S. Teixeira
- Faculty of Physical Education and Sport, Lusófona University (ULHT/FEFD), 1749-024 Lisbon, Portugal;
- Research Center in Sport, Physical Education, and Exercise and Health (CIDEFES), 1749-024 Lisbon, Portugal
| | - Rui Matos
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Raúl Antunes
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), 2415-396 Leiria, Portugal
| | - Verónica Morales-Sánchez
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology, Malaga University, 29003 Malaga, Spain;
| | - Diogo Monteiro
- Research Center in Sport, Health and Human Development (CIDESD), Trás os Montes and Alto Douro University, 5000-558 Vila Real, Portugal;
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Correspondence:
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18
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Bell T, Franz CE, Kremen WS. Persistence of pain and cognitive impairment in older adults. J Am Geriatr Soc 2022; 70:449-458. [PMID: 34741304 PMCID: PMC8821128 DOI: 10.1111/jgs.17542] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/29/2021] [Accepted: 10/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND No studies have examined the longitudinal association between the persistence of pain and its relationship to cognitive problems in older adults. The objective of this study was to examine how the persistent of pain associates with cognitive performance, cognitive impairment, and subjective memory decline. METHODS Across 10 biennial waves, 8515 adults ages 65 and over were assessed from the Health and Retirement Study (Mage = 74.17, SD = 6.87, 59.2% female). At each wave, individuals were asked to report on pain presence, and if present, rate its intensity and interference with daily activities such as housework or chores. Using running frequencies or averages, we calculated the persistence of pain using these three pain measures. Cognition was assessed using cognitive performance and different cognitive impairment cutoffs. Incident subjective memory decline was additionally measured as new self-reported memory change in the last 2 years. General estimating equations examined concurrent associations between persistence of pain and cognitive variables, adjusting for demographics, depressive symptoms, and medical comorbidities. RESULTS Persistence of pain presence was associated with an increased risk of cognitive impairment. Only persistence of pain interference, not pain intensity, was significantly associated with poorer cognitive performance or being classified as cognitively impaired. For every 2 years, persistence of pain interference was associated with 21% increased odds of cognitive impairment. Only one of three pain variables was related to incident subjective memory decline. CONCLUSIONS Persistence of pain is associated with poorer cognitive performance in community-dwelling older adults, especially when involving ongoing interference in chores and work. Facilitating pain management might be important for helping to maintain later-life cognition and reduce dementia risk.
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Affiliation(s)
- Tyler Bell
- University of California San Diego, Department of Psychiatry, San Diego, CA
| | - Carol E. Franz
- University of California San Diego, Department of Psychiatry, San Diego, CA
| | - William S. Kremen
- University of California San Diego, Department of Psychiatry, San Diego, CA
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19
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Gmuca S, Sonagra M, Xiao R, Mendoza E, Miller KS, Thomas NH, Young JF, Weiss PF, Sherry DD, Gerber JS. Characterizing Neurocognitive Impairment in Juvenile Fibromyalgia Syndrome: Subjective and Objective Measures of Dyscognition. Front Pediatr 2022; 10:848009. [PMID: 35281242 PMCID: PMC8908005 DOI: 10.3389/fped.2022.848009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our understanding of brain fog, or dyscognition, among youth with juvenile fibromyalgia syndrome is limited. We aimed to determine the prevalence of subjective (self-reported) and objective dyscognition, as well as factors associated with subjective dyscognition in juvenile fibromyalgia syndrome. METHODS A cross-sectional cohort study of patients (n = 31) 12-17 years old diagnosed with primary juvenile fibromyalgia syndrome and one of their parents from 2017 to 2019. Subjects completed a series of survey measures and patients completed a brief neurocognitive battery. Subjective dyscognition was determined based on scores on the Pediatric Quality of Life Inventory (PedsQL) Cognitive Functioning Scale and Behavior Rating Inventory of Executive Function (BRIEF-2) global executive composite (GEC). Objective dyscognition was defined as impairment of more than two standard deviations in any of the neurocognitive domains. We used Fisher's exact test or Wilcoxon rank-sum test, as appropriate, to compare clinical patients based on the presence of dyscognition. Multivariable logistic regression modeling was performed to determine factors associated with subjective dyscognition. RESULTS Of the 31 subjects, 65% reported subjective dyscognition and 39% had objective dyscognition, primarily in the domains of psychomotor speed (23%), executive function (23%), and attention (3%). Subjective dyscognition was not indicative of objective dyscognition. Subjective dyscognition was independently associated with functional disability (OR: 1.19 [95% CI: 1.02-1.40]) and anxiety (OR: 1.12 [95% CI: 1.02-1.24]). DISCUSSION Adolescents with fibromyalgia predominantly experience subjective dyscognition but more than 1/3 also experience objective dyscognition. Future research should explore the impact of interdisciplinary rehabilitation programs on the treatment of dyscognition in youth with JFMS.
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Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Maitry Sonagra
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Rui Xiao
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Elizabeth Mendoza
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Kimberly S Miller
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nina H Thomas
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Center for Human Phenomic Science Behavioral Neuroscience Core, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Child and Adolescent Psychiatry and Behavioral Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jami F Young
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Child and Adolescent Psychiatry and Behavioral Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Pamela F Weiss
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David D Sherry
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey S Gerber
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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20
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Gil-Ugidos A, Rodríguez-Salgado D, Pidal-Miranda M, Samartin-Veiga N, Fernández-Prieto M, Carrillo-de-la-Peña MT. Working Memory Performance, Pain and Associated Clinical Variables in Women With Fibromyalgia. Front Psychol 2021; 12:747533. [PMID: 34744922 PMCID: PMC8566754 DOI: 10.3389/fpsyg.2021.747533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
Working memory (WM) is a critical process for cognitive functioning in which fibromyalgia (FM) patients could show cognitive disturbances. Dyscognition in FM has been explained by interference from pain processing, which shares the neural substrates involved in cognition and may capture neural resources required to perform cognitive tasks. However, there is not yet data about how pain is related to WM performance, neither the role that other clinical variables could have. The objectives of this study were (1) to clarify the WM status of patients with FM and its relationship with nociception, and (2) to determine the clinical variables associated to FM that best predict WM performance. To this end, 132 women with FM undertook a neuropsychological assessment of WM functioning (Digit span, Spatial span, ACT tests and a 2-Back task) and a complete clinical assessment (FSQ, FIQ-R, BDI-1A, HADS, PSQI, MFE-30 questionnaires), including determination of pain thresholds and tolerance by pressure algometry. Patients with FM seem to preserve their WM span and ability to maintain and manipulate information online for both visuospatial and verbal domains. However, up to one-third of patients showed impairment in tasks requiring more short-term memory load, divided attention, and information processing ability (measured by the ACT task). Cognitive performance was spuriously related to the level of pain experienced, finding only that pain measures are related to the ACT task. The results of the linear regression analyses suggest that sleep problems and fatigue were the variables that best predicted WM performance in FM patients. Future research should take these variables into account when evaluating dyscognition in FM and should include dynamic measures of pain modulation.
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Affiliation(s)
- Antonio Gil-Ugidos
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Dolores Rodríguez-Salgado
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marina Pidal-Miranda
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Noelia Samartin-Veiga
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Montse Fernández-Prieto
- Genetics Group, GC05, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Grupo de Medicina Xenómica, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain.,U711, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain
| | - Maria Teresa Carrillo-de-la-Peña
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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21
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Mercado F, Ferrera D, Fernandes-Magalhaes R, Peláez I, Barjola P. Altered sub-processes of working memory in fibromyalgia patients: An ERP study using N-back task. PAIN MEDICINE 2021; 23:475-487. [PMID: 34145889 DOI: 10.1093/pm/pnab190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Cognitive dysfunction in fibromyalgia has become a key symptom considered by patients as more disabling than pain itself. Experimental evidence from neuropsychological and neuroimaging studies indicates that such cognitive impairments are especially robust when patients need to set in motion working memory processes, suggesting the existence of an altered functioning underlying the cerebral cortices of the frontoparietal memory network. However, the temporal dynamics of working memory sub-processes have not yet been explored in fibromyalgia. SUBJECTS Thirty-six right-handed women participated in the experiment: comprising eighteen patients with fibromyalgia and eighteen healthy controls. METHODS Event-related potentials (ERPs) and behavioural responses were recorded while participants were engaged in a 2-back working memory task. Principal Component Analyses (PCA) were used to define and quantify the ERP components associated with working memory processes. RESULTS Fibromyalgia patients exhibited worse performance than the control group, as revealed by their number of errors in the working memory task. Moreover, both scalp parieto-occipital P2 and parieto-occipital P3 amplitudes were lower for patients than for healthy control participants. Regression analyses revealed that lower P3 amplitudes were observed in those patients with fibromyalgia reporting higher pain ratings. CONCLUSIONS Current results suggest that both encoding of information (as reflected by P2) and subsequently, context updating and the replacement (as seen in lower P3 amplitudes), as a part of working memory sub-processes, are impaired in fibromyalgia. Studying the temporal dynamics of working memory using ERP methodology is a helpful approach to detect specific cognitive impaired mechanisms in this chronic pain syndrome. These new data could be used to develop more specific treatments adapted for each patient.
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Affiliation(s)
- Francisco Mercado
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - David Ferrera
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Roberto Fernandes-Magalhaes
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Clinical Foundation of the Rey Juan Carlos University, Madrid, Spain
| | - Irene Peláez
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Paloma Barjola
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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22
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Murasawa H, Pawlak A, Kobayashi H, Saeki K, Yasuda SI, Kitano Y. Mirogabalin, a novel ligand for α 2δ subunit of voltage-gated calcium channels, improves cognitive impairments in repeated intramuscular acidic saline injection model rats, an experimental model of fibromyalgia. Biomed Pharmacother 2021; 139:111647. [PMID: 33940507 DOI: 10.1016/j.biopha.2021.111647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Mirogabalin is a novel potent and selective ligand for the α2δ subunit of voltage-gated calcium channels, and shows potent and sustained analgesic effects in neuropathic pain and fibromyalgia models. Fibromyalgia is often associated with multiple comorbid symptoms, such as anxiety, depression and cognitive impairment. In the present study, we investigated the effects of mirogabalin on cognitive impairments in an experimental animal model for fibromyalgia, repeated intramuscular acidic saline injection model (Sluka model) rats. Male rats received two repeated intramuscular injections of pH 4 acidic saline into their gastrocnemius muscle. After developing mechanical hypersensitivity as identified in the von Frey test, the animals received the test substance orally once daily for 13 days and were subjected to four cognitive function tests, (Y-maze, novel object recognition, Morris water maze and step-through passive avoidance). Sluka model rats showed cognitive impairments in all four tests. Oral administration of mirogabalin (3 and 10 mg/kg) improved the cognitive impairments in these rats. In conclusion, mirogabalin improved the impaired cognitive function in Sluka model rats. It may thus also alleviate cognitive impairments as well as painful symptoms in fibromyalgia patients.
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Affiliation(s)
- Hiroyasu Murasawa
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Akiko Pawlak
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Hiroyuki Kobayashi
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Kensuke Saeki
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Shun-Ichi Yasuda
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Yutaka Kitano
- Specialty Medicine Research Laboratories I, Daiichi-Sankyo Co., Ltd., 1-2-58, Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan.
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23
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Pallanti S, Porta F, Salerno L. Adult attention deficit hyperactivity disorder in patients with fibromyalgia syndrome: Assessment and disabilities. J Psychiatr Res 2021; 136:537-542. [PMID: 33127072 DOI: 10.1016/j.jpsychires.2020.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
In the broader list of cognitive concerns, neuropsychological testing has shown that attentional impairment may have a specific burden in Fibromyalgia Syndrome (FMS). Preliminary observations have reported a subset of FMS patient screened for attention disorders fulfilling the actual diagnosis of ADHD, a neurodevelopmental disorder characterized by developmentally inadequate levels of inattention, hyperactivity and impulsivity that might persist in adulthood. Yet, no study to date has systematically examined the history and the specific contribution of ADHD to FMS in terms of clinical impact and related specific disabilities. In this study, 106 individuals with a FMS diagnosis based on the 2010 criteria of the American College of Rheumatology have been assessed for (a) the presence of ADHD; (b) the burden of disability caused by ADHD versus FMS; (c) the presence of other psychiatric disorders. Results indicated that ADHD was present in 24.5% of FMS individuals, it was associated with higher FMS symptoms severity and a greater functional impairment, particularly in the work/school domain. Moreover, patients with both FMS and ADHD had higher frequency of substance use disorders than those with FMS only (38.5% versus 3.8%) and mainly opioids. Overall, results suggest that ADHD can increase burden adding specific disability in work and social activities, and it is associated with a trend for the excessive use of opioid painkillers. Detection of neurodevelopmental and actual symptoms of ADHD is highly recommended especially in patient prone to increase the dose of anti-pain medication.
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Affiliation(s)
- Stefano Pallanti
- INS, Istituto di Neuroscienze, Florence, Italy; Albert Einstein College of Medicine (New York), Department of Psychiatry and Behavioral Sciences, USA
| | - Francesco Porta
- INS, Istituto di Neuroscienze, Florence, Italy; MedCare, Pistoia, Italy
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24
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Procento PM, Rand KL, Stewart JC, Hirsh AT. Pain Catastrophizing Mediates and Moderates the Link Between Acute Pain and Working Memory. THE JOURNAL OF PAIN 2021; 22:981-995. [PMID: 33727160 DOI: 10.1016/j.jpain.2021.03.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
The bidirectional relationship between pain and working memory (WM) deficits is well-documented but poorly understood. Pain catastrophizing-exaggerated, negative cognitive and emotional responses toward pain-may contribute to WM deficits by occupying finite, shared cognitive resources. The present study assessed the role of pain catastrophizing as both a state-level process and trait-level disposition in the link between acute pain and WM. Healthy, young adults were randomized to an experimentally-induced ischemic pain or control task, during which they completed verbal and non-verbal WM tests. Participants also completed measures of state- and trait-level pain catastrophizing. Simple mediation analyses indicated that participants in the pain group (vs. control) engaged in more state-level catastrophizing about pain, which led to worse verbal and non-verbal WM. Moderated mediation analyses indicated that the indirect (mediation) effect of state-level pain catastrophizing was moderated by trait-level pain catastrophizing for both verbal and non-verbal WM. Participants in the pain group who reported a greater trait-level tendency to catastrophize about pain experienced greater state-level catastrophizing about pain during the ischemic task, which led to worse verbal and non-verbal WM performance. These results provide evidence for pain catastrophizing as an important mechanism and moderating factor of WM deficits in acute pain. Future research should replicate these results in chronic pain samples, investigate other potential mechanisms (e.g., sleep disturbances), and determine if interventions that target pain catastrophizing directly can ameliorate cognitive deficits in people with pain. PERSPECTIVE: This article presents a laboratory study examining the relationships among pain, pain catastrophizing, and working memory in healthy participants. The results shed new light on these relationships and raise the possibility that interventions that reduce catastrophizing may lead to improved cognitive function among people with pain.
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Affiliation(s)
- Philip M Procento
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana.
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25
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Offenbaecher M, Kohls N, Ewert T, Sigl C, Hieblinger R, Toussaint LL, Sirois F, Hirsch J, Vallejo MA, Kramer S, Rivera J, Stucki G, Schelling J, Winkelmann A. Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective "real world" data analysis of fibromyalgia patients. Rheumatol Int 2021; 41:1995-2006. [PMID: 33666726 DOI: 10.1007/s00296-020-04702-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM). METHODS In this cross-sectional, observational study, "real world" data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses. RESULTS The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (- 0.22), pain-related interference with everyday life (- 0.19), general activity (0.13), general health perception (0.11), punishing response from others (- 0.11), work status (- 0.10), vitality (- 0.11) and cognitive difficulties (- 0.12). Pain intensity or frequency was not an independent correlate. CONCLUSIONS More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.
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Affiliation(s)
- Martin Offenbaecher
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany. .,Gasteiner Heilstollen Clinic, Heilstollenstr. 19, 5645, Bad Gastein, Austria.
| | - Niko Kohls
- Division of Integrative Health Promotion, University of Applied Science and Arts, Coburg, Germany
| | - Thomas Ewert
- Bavarian Health and Food Safety Authority, Nuremberg, Germany
| | - Claudia Sigl
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Robin Hieblinger
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | | | - Fuschia Sirois
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jameson Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, USA
| | | | - Sybille Kramer
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Javier Rivera
- Rheumatology Unit, Rehabilitation Provincial Institute, "Gregorio Marañón" General Hospital, Madrid, Spain
| | - Gerold Stucki
- Department Health Sciences and Medicine, University of Luzern, Luzern, Switzerland
| | | | - Andreas Winkelmann
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
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26
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Tiwari VK, Nanda S, Arya S, Kumar U, Sharma R, Kumaran SS, Bhatia R. Correlating cognition and cortical excitability with pain in fibromyalgia: a case control study. Adv Rheumatol 2021; 61:10. [PMID: 33602339 DOI: 10.1186/s42358-021-00163-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal symptoms, primarily attributed to sensitization of somatosensory system carrying pain. Few reports have investigated the impact of fibromyalgia symptoms on cognition, corticomotor excitability, sleepiness, and the sleep quality - all of which can deteriorate the quality of life in fibromyalgia. However, the existing reports are underpowered and have conflicting directions of findings, limiting their generalizability. Therefore, the present study was designed to compare measures of cognition, corticomotor excitability, sleepiness, and sleep quality using standardized instruments in the recruited patients of fibromyalgia with pain-free controls. METHODS Diagnosed cases of fibromyalgia were recruited from the Rheumatology department for the cross-sectional, case-control study. Cognition (Mini-Mental State Examination, Stroop color-word task), corticomotor excitability (Resting motor threshold, Motor evoked potential amplitude), daytime sleepiness (Epworth sleepiness scale), and sleep quality (Pittsburgh sleep quality index) were studied according to the standard procedure. RESULTS Thirty-four patients of fibromyalgia and 30 pain-free controls were recruited for the study. Patients of fibromyalgia showed decreased cognitive scores (p = 0.05), lowered accuracy in Stroop color-word task (for color: 0.02, for word: 0.01), and prolonged reaction time (< 0.01, < 0.01). Excessive daytime sleepiness in patients were found (< 0.01) and worsened sleep quality (< 0.01) were found. Parameters of corticomotor excitability were comparable between patients of fibromyalgia and pain-free controls. CONCLUSIONS Patients of fibromyalgia made more errors, had significantly increased reaction time for cognitive tasks, marked daytime sleepiness, and impaired quality of sleep. Future treatment strategies may include cognitive deficits and sleep disturbances as an integral part of fibromyalgia management.
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Affiliation(s)
- Vikas Kumar Tiwari
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Srishti Nanda
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Suvercha Arya
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kumar
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - Ratna Sharma
- Stress and Cognition Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Senthil S Kumaran
- Department of Nuclear Magnetic Resonance and MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Bhatia
- Pain Research and TMS Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
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27
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Castel A, Cascón-Pereira R, Boada S. Memory complaints and cognitive performance in fibromyalgia and chronic pain: The key role of depression. Scand J Psychol 2021; 62:328-338. [PMID: 33538343 DOI: 10.1111/sjop.12706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/19/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
To explore the relationship between perceived cognitive problems and cognitive performance in three different samples, taking into account the possible influence of depression, catastrophizing, pain intensity, or medication. Seventy individuals with fibromyalgia, 74 with non-malignant chronic pain and 40 pain-free controls, completed measures of verbal episodic memory, sustained attention, response inhibition, depression, catastrophizing, and pain intensity. Fibromyalgia and chronic pain patients performed worse than controls in verbal memory and sustained attention, but these differences disappeared when depressed participants were excluded from the analyses. Memory complaints were related with depression in all pain patients. However, in the case of fibromyalgia, memory complaints were also related by pain intensity and inversely related by short-term episodic memory. This case-control study shows the importance of jointly assessing cognitive performance and memory complaints and of controlling for variables such as depression, catastrophizing, pain intensity and medication in the studied samples. Accordingly, this study highlights the differences in memory complaints, between the patients with fibromyalgia and the patients with other chronic pain conditions. Finally, it has highlighted the important role played by depression in cognitive performance and memory complaints considering the Neurocognitive Model of Attention to pain.
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Affiliation(s)
- Antoni Castel
- Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.,Multidimentional Pain Research Group, Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Rosalia Cascón-Pereira
- Multidimentional Pain Research Group, Institut d'Investigació Sanitària Pere Virgili, Reus, Spain.,Business Management Unit, Universitat Rovira i Virgili, Reus, Spain
| | - Sergi Boada
- Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
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28
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Lagogianni C, Gatzonis S, Patrikelis P. Fatigue and cognitive functions in epilepsy: A review of the literature. Epilepsy Behav 2021; 114:107541. [PMID: 33243688 DOI: 10.1016/j.yebeh.2020.107541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
Epilepsy is a common neurological disorder affecting people of all ages and inducing cognitive impairments. While research has advanced in terms of neuropsychological enquiries of the various epileptic syndromes, the understanding of more complex and ill-defined phenomena such as fatigue is still unclear for epilepsy. It is suggested that fatigue is not just physical, but there can also be a cognitive element to it. Although studies in other conditions have been able to identify a relationship between fatigue and particular cognitive components, similar evidence is sparse in patients with epilepsy. This review is an attempt to gather, analyze, integrate, and critically discuss available information on fatigue and its rapport with various aspects of epilepsy, particularly focusing on cognition. Future directions are discussed urging researchers to target cognitive components of fatigue.
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Affiliation(s)
- Christodouli Lagogianni
- Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece; ICPS College for Humanistic Sciences, Athens, Greece.
| | - Stylianos Gatzonis
- Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece
| | - Panayiotis Patrikelis
- Department of Neurosurgery, Epilepsy Surgery Unit, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece
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29
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Steiner GZ, Barry RJ, Wassink K, De Blasio FM, Fogarty JS, Cave AE, Love S, Armour M. Neuronal Correlates of Cognitive Control Are Altered in Women With Endometriosis and Chronic Pelvic Pain. Front Syst Neurosci 2020; 14:593581. [PMID: 33390910 PMCID: PMC7772245 DOI: 10.3389/fnsys.2020.593581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022] Open
Abstract
Endometriosis is a debilitating women's health condition and is the most common cause of chronic pelvic pain. Impaired cognitive control is common in chronic pain conditions, however, it has not yet been investigated in endometriosis. The aim of this study was to explore the neuronal correlates of cognitive control in women with endometriosis. Using a cross-sectional study design with data collected at a single time-point, event-related potentials were elicited during a cued continuous performance test from 20 women with endometriosis (mean age = 28.5 ± 5.2 years) and 20 age- and gender-matched controls (mean age = 28.5 ± 5.2 years). Event-related potential components were extracted and P3 component amplitudes were derived with temporal principal components analysis. Behavioral and ERP outcomes were compared between groups and subjective pain severity was correlated with ERP component amplitudes. No significant behavioral differences were seen in task performance between the groups (all p > 0.094). Target P3b (all p < 0.034) and SW (all p < 0.040), and non-target early P3a (eP3a; all p < 0.023) and late P3a (lP3a; all p < 0.035) amplitudes were smaller for the endometriosis compared to the healthy control group. Lower non-target eP3a (p < 0.001), lP3a (p = 0.013), and SW (p = 0.019) amplitudes were correlated with higher pain severity scores. Findings suggest that endometriosis-associated chronic pelvic pain is linked to alterations in stimulus-response processing and inhibitory control networks, but not impaired behavioral performance, due to compensatory neuroplastic changes in overlapping cognitive control and pain networks.
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Affiliation(s)
- Genevieve Z Steiner
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia.,Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Robert J Barry
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Katherine Wassink
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Frances M De Blasio
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Jack S Fogarty
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Adele E Cave
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
| | - Sapphire Love
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Mike Armour
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
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30
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Kratz AL, Whibley D, Kim S, Sliwinski M, Clauw D, Williams DA. Fibrofog in Daily Life: An Examination of Ambulatory Subjective and Objective Cognitive Function in Fibromyalgia. Arthritis Care Res (Hoboken) 2020; 72:1669-1677. [PMID: 31609548 PMCID: PMC7153985 DOI: 10.1002/acr.24089] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/08/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Perceived cognitive dysfunction in fibromyalgia (FM), "fibrofog," is common. Prior laboratory-based studies have limited our understanding of cognitive function in FM in daily life. The objective of this study was to explore levels of subjective and objective cognitive functioning and the association between subjective and objective aspects of cognition in people with and without FM in the lived environment. METHODS Participants (n = 50 adults with FM; n = 50 adults without FM, matched for age, sex, and education) completed baseline measures of subjective and objective cognitive functioning (NIH Toolbox). They also completed ecological momentary assessments of cognitive clarity and speed and tests of processing speed and working memory, via a smart phone app, 5×/day for 8 days. RESULTS On baseline objective measures, the FM group demonstrated poorer cognitive functioning across 3 NIH Toolbox tests. There were no strong correlations between subjective and objective cognitive functioning in both the FM and control groups. In the lived environment, the FM group demonstrated poorer subjective cognition and objective working memory; groups did not differ on processing speed. Momentary ratings of subjective cognitive dysfunction were significantly related to changes in objective processing speed but not working memory, with no group differences. CONCLUSION Findings indicate worse laboratory-based and ambulatory subjective and objective cognitive function for those individuals with FM compared to those without FM. Similar associations between measures of subjective and objective cognitive functioning for the groups suggest that people with FM are not overstating cognitive difficulties. Future research examining contributors to ambulatory fibrofog is warranted.
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Affiliation(s)
- Anna L. Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Daniel Whibley
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - Samsuk Kim
- Department of Psychology, University of Detroit Mercy, Detroit, MI
| | - Martin Sliwinski
- Center for Healthy Aging, Pennsylvania State University, University Park, PA
| | - Daniel Clauw
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - David A. Williams
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI
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Robinson LK, McFadden SL. Distinguishing TBI Malingering and Fatigue Using Event-Related Potentials. J PSYCHOPHYSIOL 2020. [DOI: 10.1027/0269-8803/a000248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Poorer-than-expected performance on cognitive-behavioral tasks may indicate malingering, or it could be an outcome of fatigue, resulting in false positives when suboptimal task performance is used to flag individuals feigning or exaggerating symptoms of traumatic brain injury (TBI). The primary goal of this study was to examine the P3 event-related potentials (ERP) and behavioral outcomes associated with TBI malingering and fatigue, in order to distinguish between them. A secondary goal was to determine if history of TBI (hTBI) is associated with differences in fatigue, ERPs, or performance on a short-term memory task. Participants completed the Mental Fatigue and Related Symptoms (SR-MF) questionnaire and were interviewed to assess TBI history, then they completed a computerized “old/new” (match-mismatch) task while ERPs were recorded, under three conditions: Normal, Malinger, and Fatigue. Participants reported mild fatigue at the end of study, with no difference between individuals reporting a history of TBI ( n = 32) and healthy controls ( n = 47). Fatigue was associated with prolonged P3 latency but was otherwise indistinguishable from Normal. In contrast, Malinger was clearly distinguished from Normal by significantly lower accuracy, longer reaction times, reduced P3 amplitude on Match trials, and a smaller old/new ERP effect. Individuals with a history of TBI reported clinical levels of fatigue at baseline but did not differ significantly from healthy controls on any behavioral or ERP measure. The results support the use of behavioral and ERP measures to identify malingering, without concern over confounding effects of mild subjective fatigue, including mild fatigue induced by testing.
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Erdodi LA, Abeare CA. Stronger Together: The Wechsler Adult Intelligence Scale-Fourth Edition as a Multivariate Performance Validity Test in Patients with Traumatic Brain Injury. Arch Clin Neuropsychol 2020; 35:188-204. [PMID: 31696203 DOI: 10.1093/arclin/acz032] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/18/2019] [Accepted: 06/22/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study was designed to evaluate the classification accuracy of a multivariate model of performance validity assessment using embedded validity indicators (EVIs) within the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). METHOD Archival data were collected from 100 adults with traumatic brain injury (TBI) consecutively referred for neuropsychological assessment in a clinical setting. The classification accuracy of previously published individual EVIs nested within the WAIS-IV and a composite measure based on six independent EVIs were evaluated against psychometrically defined non-credible performance. RESULTS Univariate validity cutoffs based on age-corrected scaled scores on Coding, Symbol Search, Digit Span, Letter-Number-Sequencing, Vocabulary minus Digit Span, and Coding minus Symbol Search were strong predictors of psychometrically defined non-credible responding. Failing ≥3 of these six EVIs at the liberal cutoff improved specificity (.91-.95) over univariate cutoffs (.78-.93). Conversely, failing ≥2 EVIs at the more conservative cutoff increased and stabilized sensitivity (.43-.67) compared to univariate cutoffs (.11-.63) while maintaining consistently high specificity (.93-.95). CONCLUSIONS In addition to being a widely used test of cognitive functioning, the WAIS-IV can also function as a measure of performance validity. Consistent with previous research, combining information from multiple EVIs enhanced the classification accuracy of individual cutoffs and provided more stable parameter estimates. If the current findings are replicated in larger, diagnostically and demographically heterogeneous samples, the WAIS-IV has the potential to become a powerful multivariate model of performance validity assessment. BRIEF SUMMARY Using a combination of multiple performance validity indicators embedded within the subtests of theWechsler Adult Intelligence Scale, the credibility of the response set can be establishedwith a high level of confidence. Multivariatemodels improve classification accuracy over individual tests. Relying on existing test data is a cost-effective approach to performance validity assessment.
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Affiliation(s)
- Laszlo A Erdodi
- Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, ON, Canada
| | - Christopher A Abeare
- Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, ON, Canada
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Effects of COMT Genotypes on Working Memory Performance in Fibromyalgia Patients. J Clin Med 2020; 9:jcm9082479. [PMID: 32752289 PMCID: PMC7464119 DOI: 10.3390/jcm9082479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022] Open
Abstract
Growing research has reported the presence of a clear impairment of working memory functioning in fibromyalgia. Although different genetic factors involving dopamine availability (i.e, the COMT gene) have been associated with the more severe presentation of key symptoms in fibromyalgia, scientific evidence regarding the influence of COMT genotypes on cognitive impairment in these patients is still lacking. To this end, 167 participants took part in the present investigation. Working memory performance was assessed by the application of the SST (Spatial Span Test) and LNST (Letter and Number Sequence Test) belonging to the Weschler Memory Scale III. Significant working memory impairment was shown by the fibromyalgia patients. Remarkably, our results suggest that performance according to different working memory measures might be influenced by different genotypes of the COMT gene. Specifically, fibromyalgia patients carrying the Val/Val genotype exhibited significantly worse outcomes for the span of SST backward, SST backward score, SST total score and the Working Memory Index (WMI) than the Val/Val healthy carriers. Furthermore, the Val/Val patients performed worse on the SST backward and SST score than heterozygotes. Our findings are the first to show a link between the COMT gene and working memory dysfunction in fibromyalgia, supporting the idea that higher COMT enzyme activity would contribute to more severe working memory impairment in fibromyalgia.
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Anderson JFI, Jordan AS. An observational study of the association between sleep disturbance, fatigue and cognition in the post-acute period after mild traumatic brain injury in prospectively studied premorbidly healthy adults. Neuropsychol Rehabil 2020; 31:1444-1465. [PMID: 32558623 DOI: 10.1080/09602011.2020.1781665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The literature examining the relationship between sleep disturbance, fatigue, and cognition in premorbidly healthy civilian adults after mTBI is very limited. The current study aimed to investigate the relationships of sleep disturbance and fatigue with cognition while controlling for psychological distress and age. Using a prospective observational design, we assessed 60 premorbidly healthy individuals approximately 8 weeks after mTBI. Participants were assessed with the Pittsburgh Sleep Quality Index and the Multidimensional Fatigue Inventory as well as measures of speed of information processing, attention, memory, and executive function; depression and anxiety were also assessed. Findings revealed associations between sleep disturbance and cognition (r2 = .586, p < .001) as well as between fatigue and cognition (r2 = .390, p < .01), independent of the impact of psychological status and age. Associations were evident in the domains of processing speed, attention, and memory, but were most consistently apparent on measures of executive function. Greater sleep disturbance was most consistently associated with poorer cognitive function. Unexpectedly, higher levels of fatigue were associated with better cognitive function, which may be explained by the coping hypothesis. Given sleep interventions have been shown to improve sleep disturbance, these findings suggest that sleep intervention may also result in improved cognition after mTBI.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Senior Clinical Neuropsychologist, Psychology Department, The Alfred Hospital, Prahran, Australia
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
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35
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Cognitive Complaints in Motor Functional Neurological (Conversion) Disorders: A Focused Review and Clinical Perspective. Cogn Behav Neurol 2020; 33:77-89. [DOI: 10.1097/wnn.0000000000000218] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huber BN, Jones RG, Capps SC, Buchanan EM. Memory complaints inventory profiles: Differentiating neurocognitive impairment, depression, and non-credible performance. APPLIED NEUROPSYCHOLOGY. ADULT 2020; 29:234-243. [PMID: 32186416 DOI: 10.1080/23279095.2020.1735388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Memory Complaints Inventory (MCI) is a symptom validity measure designed to assess exaggerated memory complaints. The aim of current study was to develop memory complaint profiles on the MCI to distinguish between various neurocognitive disorders, depression, and non-credible performance. This study utilized MCI scores (N = 244) from a neuropsychology clinic to determine the presence of, and difference between, subjective memory complaints between a depression group, non-credible group, and subgroups of cognitive impairment (Alzheimer's Dementia, Vascular Dementia, and Mild Cognitive Impairment). Significant differences were found on MCI endorsement between cognitive impairment, depression, and non-credible groups. This pattern indicated fewer memory complaints for cognitive impairment groups when compared to depression and non-credible groups; the non-credible group had the highest MCI scores overall. ROC analyses revealed recommended clinical cutoff values with high specificity for distinguishing between the non-credible group and other groups. The findings provided further evidence for the MCI as a symptom validity measure, given its ability to differentiate between a non-credible group and clinical groups. Replication of the study's findings would result in reliable genuine subjective memory complaint profiles to provide additional diagnostic and prognostic specificity in neuropsychological practice.
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Affiliation(s)
- Becca N Huber
- Psychology, Idaho State University, Pocatello, ID, USA.,Psychology, Missouri State University, Springfield, MO, USA
| | - Ryan G Jones
- Neuropsychology, CoxHealth, Springfield, MO, USA
| | - Steven C Capps
- Psychology, Missouri State University, Springfield, MO, USA
| | - Erin M Buchanan
- Psychology, Missouri State University, Springfield, MO, USA.,Cognitive Analytics, Harrisburg University of Science and Technology, Harrisburg, PA, USA
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37
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Hollins M, Bryen CP, Taylor D. Effects of chronic pain history on perceptual and cognitive inhibition. Exp Brain Res 2020; 238:321-332. [PMID: 31907554 DOI: 10.1007/s00221-019-05715-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023]
Abstract
Measures of sensory and cognitive inhibition were obtained from university students with and without a history of chronic pain. The form of sensory inhibition measured was diffuse noxious inhibitory controls (DNIC), the capacity of a painful stimulus to reduce the subjective intensity of a second stimulus delivered to a remote body site. To measure cognitive inhibition, the Stroop effect was used. Participants with a history of chronic pain showed less DNIC (i.e., less sensory inhibition) than the healthy controls, but had a smaller Stroop effect (indicating greater cognitive inhibition). The fact that chronic pain history is associated with opposite changes in these two measures casts doubt on the view that the two inhibitory processes are related. Scores on each experimental measure were equivalent in pain-history subjects with ongoing chronic pain and those whose chronic pain had resolved. This equivalence suggests that chronic pain in childhood or adolescence may have lingering effects on sensory and cognitive inhibition.
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Affiliation(s)
- Mark Hollins
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Chloe P Bryen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Dillon Taylor
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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38
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Olla P, Rykulski N, Hurtubise JL, Bartol S, Foote R, Cutler L, Abeare K, McVinnie N, Sabelli AG, Hastings M, Erdodi LA. Short-term effects of cannabis consumption on cognitive performance in medical cannabis patients. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:647-657. [PMID: 31790276 DOI: 10.1080/23279095.2019.1681424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This observational study examined the acute cognitive effects of cannabis. We hypothesized that cognitive performance would be negatively affected by acute cannabis intoxication. Twenty-two medical cannabis patients from Southwestern Ontario completed the study. The majority (n = 13) were male. Mean age was 36.0 years, and mean level of education was 13.7 years. Participants were administered the same brief neurocognitive battery three times during a six-hour period: at baseline ("Baseline"), once after they consumed a 20% THC cannabis product ("THC"), and once again several hours later ("Recovery"). The average self-reported level of cannabis intoxication prior to the second assessment (i.e., during THC) was 5.1 out of 10. Contrary to expectations, performance on neuropsychological tests remained stable or even improved during the acute intoxication stage (THC; d: .49-.65, medium effect), and continued to increase during Recovery (d: .45-.77, medium-large effect). Interestingly, the failure rate on performance validity indicators increased during THC. Contrary to our hypothesis, there was no psychometric evidence for a decline in cognitive ability following THC intoxication. There are several possible explanations for this finding but, in the absence of a control group, no definitive conclusion can be reached at this time.
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Affiliation(s)
| | - Nicholas Rykulski
- College of Human Medicine, Michigan State University, Lansing, MI, USA
| | | | - Stephen Bartol
- School of Medicine, Wayne State University, Detroit, MI, USA
| | | | - Laura Cutler
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Kaitlyn Abeare
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Nora McVinnie
- Brain-Cognition-Neuroscience Program, University of Windsor, Windsor, ON, Canada
| | - Alana G Sabelli
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Maurissa Hastings
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Laszlo A Erdodi
- Department of Psychology, University of Windsor, Windsor, ON, Canada
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Emotional Influences on Cognitive Processing in Fibromyalgia Patients With Different Depression Levels: An Event-related Potential Study. Clin J Pain 2019; 34:1106-1113. [PMID: 29975206 DOI: 10.1097/ajp.0000000000000637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Comorbid symptoms in fibromyalgia (FM) syndrome, such as mood disorders and cognitive dysfunction, may lead to greater functional impairment than pain itself. This study aimed to unravel the modulating role of depression in response execution and inhibition in FM using an emotional go/no-go task. MATERIALS AND METHODS In total, 17 FM patients with low depression, 18 FM patients with high depression, and 18 pain-free controls were included. Pain, happy, and neutral faces were pseudorandomly presented, and participants were asked to respond to male faces (go trials) by pressing a button, and to inhibit their responses if female faces were presented (no-go trials). RESULTS FM patients with high depression showed lower positive affect scores, higher negative affect and pain vigilance scores, and slower reaction times, than FM patients with low depression and pain-free controls. Both subgroups of FM patients also rated pain faces as more arousing than pain-free controls. The lack of group differences in our electrophysiological data, neither in N200 nor in P300 amplitudes, seems to indicate that there was no significant impairment in response execution in response inhibition due to pain. DISCUSSION Taken together, these results add evidence to the notion that depression is associated with higher affective dysregulation and deficit of information-processing speed in FM. Furthermore, our data suggest that pain induces a bias to pain-related information, but the absence of significant group differences in event-related potential amplitudes, calculated with analyses of covariance (ANCOVA) (with pain intensity), seem to show that pain intensity is not a predictor for cognitive dysfunctions.
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40
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Bunk S, Preis L, Zuidema S, Lautenbacher S, Kunz M. Executive Functions and Pain. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2019. [DOI: 10.1024/1016-264x/a000264] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. A growing body of literature suggests that chronic-pain patients suffer from problems in various neuropsychological domains, including executive functioning. In order to better understand which components of executive functioning (inhibition, shifting and/or updating) might be especially affected by pain and which mechanisms might underlie this association, we conducted a systematic review, including both chronic-pain studies as well as experimental-pain studies. The chronic-pain studies (N = 57) show that pain is associated with poorer executive functioning. The findings of experimental-pain studies (N = 28) suggest that this might be a bidirectional relationship: Pain can disrupt executive functioning, but poorer executive functioning might also be a risk factor for higher vulnerability to pain.
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Affiliation(s)
- Stefanie Bunk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, The Netherlands
| | - Lukas Preis
- Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, The Netherlands
| | | | - Miriam Kunz
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, The Netherlands
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Rai JK, Erdodi LA. Impact of criterion measures on the classification accuracy of TOMM-1. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:185-196. [PMID: 31187632 DOI: 10.1080/23279095.2019.1613994] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study was designed to examine the effect of various criterion measures on the classification accuracy of Trial 1 of the Test of Memory Malingering (TOMM-1), a free-standing performance validity test (PVT). Archival data were collected from a case sequence of 91 (M Age = 42.2 years; M Education = 12.7) patients clinically referred for neuropsychological assessment. Trials 2 and Retention of the TOMM, the Word Choice Test, and three validity composites were used as criterion PVTs. Classification accuracy varied systematically as a function of criterion PVT. TOMM-1 ≤ 43 emerged as the optimal cutoff, resulting in a wide range of sensitivity (.47-1.00), with perfect overall specificity. Failing the TOMM-1 was unrelated to age, education or gender, but was associated with elevated self-reported depression. Results support the utility of TOMM-1 as an independent, free-standing, single-trial PVT. Consistent with previous reports, the choice of criterion measure influences parameter estimates of the PVT being calibrated. The methodological implications of modality specificity to PVT research and clinical/forensic practice should be considered when evaluating cutoffs or interpreting scores in the failing range.
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Affiliation(s)
- Jaspreet K Rai
- Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, Ontario, Canada.,University of Windsor, Edmonton, Alberta, Canada
| | - Laszlo A Erdodi
- Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, Ontario, Canada
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43
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Erdodi LA, Taylor B, Sabelli AG, Malleck M, Kirsch NL, Abeare CA. Demographically Adjusted Validity Cutoffs on the Finger Tapping Test Are Superior to Raw Score Cutoffs in Adults with TBI. PSYCHOLOGICAL INJURY & LAW 2019. [DOI: 10.1007/s12207-019-09352-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kim JH. Effect of depressive disorder on cognitive decline. Arch Gerontol Geriatr 2019; 83:211-216. [PMID: 31096098 DOI: 10.1016/j.archger.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/22/2019] [Accepted: 05/07/2019] [Indexed: 11/29/2022]
Abstract
This study longitudinally investigates the effect of depressive disorder on psychiatric disorder in middle aged and aged population from the Korean Longitudinal Study of Aging. Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2016 was assessed using longitudinal data analysis and 7515 research samples were included after excluding those with cognitive decline and missing information at baseline (2006). To analyze the association between depressive disorder on cognitive decline in middle aged and aged population, generalized estimating equation (GEE) model and chi-square test were used. The association between depressive symptom during a week and center for epidemiological studies depression (CESD) on cognitive decline was statistically significant, respectively with the following Odds ratio (OR) predicting decreased MMSE score: OR = 0.89 (p < .0001) for 5-7 days vs. less than a day and B = 0.91 (p < .0001) for depression (8-10) vs. healthy (zero). In terms of cognitive decline, depressive symptom was higher for 5-7 days (OR = 3.79, p < .0001) compared to less than a day. This study shows a statistically significant association between depressive disorder and cognitive decline in a Korean middle aged and aged population. These findings suggest the importance of managing depressive disorder for incident cognitive decline.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea; Institute of Health Promotion and Policy, Dankook University, Cheonan, Republic of Korea.
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45
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Samartin-Veiga N, González-Villar AJ, Carrillo-de-la-Peña MT. Neural correlates of cognitive dysfunction in fibromyalgia patients: Reduced brain electrical activity during the execution of a cognitive control task. Neuroimage Clin 2019; 23:101817. [PMID: 30999252 PMCID: PMC6468193 DOI: 10.1016/j.nicl.2019.101817] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Fibromyalgia (FM) is a generalized chronic pain syndrome of unknown aetiology. Although FM patients frequently complain of cognitive dysfunction, this is one of the least studied symptoms. Research on brain activity associated with the perceived cognitive impairment is particularly scarce. To address this gap, we recorded the brain electrical activity in participants during a cognitive control task. METHODS Electroencephalograms (EEGs) were recorded in 19 FM patients and 22 healthy controls (all women) while they performed the Multi-Source Interference Task (MSIT). We analyzed the amplitude of the frontal N2 and parietal P3 components elicited in control and interference trials and their relation with reaction times. We also explored the relationship of perceived cognitive dysfunction, assessed using visual analogue scales (VAS) and the Memory Failures of Everyday (MFE-30) test, with N2 and P3 amplitudes. RESULTS The N2 amplitudes were smaller in FM patients than in controls and were negatively associated with cognitive complaints. Unlike patients, healthy controls showed significant differences in the amplitude of P3 obtained from control vs. interference trials of the MSIT. Smaller N2 and P3 amplitudes were associated to longer reaction times. CONCLUSIONS The findings suggest a reduction in frontal brain activity during performance of an interference task, which was associated with the patients' cognitive complaints. Findings on P3 suggest altered modulation of attention according to the task demands in FM patients. Deficits in flexibility in the allocation of attentional resources and cognitive control during complex tasks may explain the dyscognition reported by chronic pain patients.
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Affiliation(s)
- N Samartin-Veiga
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - A J González-Villar
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Psychological Neuroscience Lab, Research Center in Psychology, School of Psychology, University of Minho, Braga, Portugal
| | - M T Carrillo-de-la-Peña
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Ojeda B, Dueñas M, Salazar A, Mico JA, Torres LM, Failde I. Factors Influencing Cognitive Impairment in Neuropathic and Musculoskeletal Pain and Fibromyalgia. PAIN MEDICINE 2019; 19:499-510. [PMID: 28340167 DOI: 10.1093/pm/pnx024] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective To assess cognitive performance of chronic pain (CP) patients diagnosed with three types of pain-neuropathic pain (NP), musculoskeletal (MSK), and fibromyalgia (FM)-and to analyze the factors influencing cognitive difficulties in each group. Methods Two hundred fifty-four CP patients-104 NP, 99 MSK, 51 FM-and 72 pain-free subjects were included in the study. The "Test Your Memory" (TYM) scale was used to assess cognitive performance. Pain intensity was measured by means of the visual analog scale (VAS); the Hospital Anxiety and Depression scale was used to assess mental status, and the Medical Outcome Study (MOS) sleep scale to assess sleep quality. The relationships between cognitive performance and these factors were analyzed using linear regression models. Results The mean score in the TYM was significantly lower (worse cognitive function) in CP patients than controls (40.5 vs 43.9, P < 0.001). In the separate analysis of each group, depression was observed to have a negative impact on MSK pain patients (ß = -0.37, 95% confidence interval [CI] = -0.53 to -0.2, P < 0.001) and on FM subjects (ß =-1.01, 95% CI = -1.05 to -2.38, P = 0.022). A significant interaction between pain intensity and depression was observed in the FM patients. In addition, a U-shaped association was found between the duration of pain and cognitive performance in the NP patients. Neither anxiety nor sleep impairment affected cognitive performance in any of the CP patients. Conclusions These results highlight the importance of taking into account the type of pain when assessing cognitive performance in CP patients and demonstrate the influence of the emotional state of the patient, especially if depression is present.
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Affiliation(s)
- Begoña Ojeda
- Preventive Medicine and Public Health Area, The Observatory of Pain (External Chair of Pain)
| | - María Dueñas
- Salus Infirmorum Faculty of Nursing
- Department of Neuroscience, Pharmacology and Psychiatry, CIBER of Mental Health, CIBERSAM, Instituto de Salud Carlos III, University of Cádiz, Spain
| | - Alejandro Salazar
- Preventive Medicine and Public Health Area, The Observatory of Pain (External Chair of Pain)
- Department of Neuroscience, Pharmacology and Psychiatry, CIBER of Mental Health, CIBERSAM, Instituto de Salud Carlos III, University of Cádiz, Spain
| | - Juan Antonio Mico
- Department of Neuroscience, Pharmacology and Psychiatry, CIBER of Mental Health, CIBERSAM, Instituto de Salud Carlos III, University of Cádiz, Spain
- Department of Anesthesiology, Critical Care and Pain Management, University Hospital "Puerta del Mar," Cádiz, Spain
| | - Luis Miguel Torres
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - Inmaculada Failde
- Preventive Medicine and Public Health Area, The Observatory of Pain (External Chair of Pain)
- Department of Neuroscience, Pharmacology and Psychiatry, CIBER of Mental Health, CIBERSAM, Instituto de Salud Carlos III, University of Cádiz, Spain
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47
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Ezzati A, Wang C, Katz MJ, Derby CA, Zammit AR, Zimmerman ME, Pavlovic JM, Sliwinski MJ, Lipton RB. The Temporal Relationship between Pain Intensity and Pain Interference and Incident Dementia. Curr Alzheimer Res 2019; 16:109-115. [PMID: 30543173 PMCID: PMC6484854 DOI: 10.2174/1567205016666181212162424] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/17/2018] [Accepted: 12/02/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic pain is common among older adults and is associated with cognitive dysfunction based on cross-sectional studies. However, the longitudinal association between chronic pain and incident dementia in community-based samples is unknown. OBJECTIVE We aimed to evaluate the association of pain intensity and pain interference with incident dementia in a community-based sample of older adults. METHODS Participants were 1,114 individuals 70 years of age or older from Einstein Aging Study (EAS), a longitudinal cohort study of community-dwelling older adults in the Bronx County, NY. The primary outcome measure was incident dementia, diagnosed using DSM-IV criteria. Pain intensity and interference in the month prior to first annual visit were measured using items from the SF-36 questionnaire. Pain intensity and pain interference were assessed as predictors of time to incident dementia using Cox proportionate hazards models while controlling for potential confounders. RESULTS Among participants, 114 individuals developed dementia over an average 4.4 years (SD=3.1) of follow-up. Models showed that pain intensity had no significant effect on time to developing dementia, whereas higher levels of pain interference were associated with a higher risk of dementia. In the model that included both pain intensity and interference as predictors of incident dementia, pain interference had a significant effect on incident dementia, and pain intensity remained non-significant. CONCLUSION As a potential remediable risk factor, the mechanisms linking pain interference to cognitive decline merit further exploration.
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Affiliation(s)
- Ali Ezzati
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Neurology, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mindy J. Katz
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Carol A. Derby
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Andrea R. Zammit
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Molly E. Zimmerman
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Psychology, Fordham University, Bronx, NY10604, USA
| | - Jelena M. Pavlovic
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Neurology, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Martin J. Sliwinski
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, PA, USA
| | - Richard B. Lipton
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Neurology, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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A comprehensive literature review of chronic pain and memory. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:183-192. [PMID: 28797640 DOI: 10.1016/j.pnpbp.2017.08.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/29/2017] [Accepted: 08/05/2017] [Indexed: 12/22/2022]
Abstract
Chronic pain patients often complain of their "poor memory" and numerous studies objectively confirmed such difficulties in reporting working memory (WM) and long-term memory (LTM) dysfunctions. This paper provides a comprehensive review of the literature on memory impairment in chronic pain (CP) patients. Twenty-four observational studies evaluating WM or/and LTM in a chronic pain group and a control group were included in this review. Results showed that studies consistently reported a moderate decline, in both WM and LTM performances in CP patients. Even if CP patients complained about forgetfulness, objective measurements did not permit to conclude to a long-term storage impairment. CP patients exhibited more specifically encoding or retrieving difficulties compared to controls. Results showed that chronic pain selectively impacted the most attention-demanding memory processes, such as working memory and recollection in long-term memory. Results also demonstrated that CP patients exhibited a memory bias directed towards painful events compared to control subjects. Several authors have suggested that CP could be a maladaptive consequence of memory mechanisms. The long-lasting presence of pain continuously reinforces aversive emotional associations with incidental events. The inability to extinguish this painful memory trace could explain the chronic persistence of pain even when the original injury has disappeared. A major concern is the need to extricate pain-related cognitive effects from those resulting from all the co-morbidities associated with CP which both have a deleterious effect on cognitive function.
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49
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Teodoro T, Edwards MJ, Isaacs JD. A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry 2018; 89:1308-1319. [PMID: 29735513 PMCID: PMC6288708 DOI: 10.1136/jnnp-2017-317823] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/24/2018] [Accepted: 04/10/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Functional cognitive disorder (FCD) describes cognitive dysfunction in the absence of an organic cause. It is increasingly prevalent in healthcare settings yet its key neuropsychological features have not been reported in large patient cohorts. We hypothesised that cognitive profiles in fibromyalgia (FM), chronic fatigue syndrome (CFS) and functional neurological disorders (FNDs) would provide a template for characterising FCD. METHODS We conducted a systematic review of studies with cognition-related outcomes in FM, CFS and FND. RESULTS We selected 52 studies on FM, 95 on CFS and 39 on FND. We found a general discordance between high rates of subjective cognitive symptoms, including forgetfulness, distractibility and word-finding difficulties, and inconsistent objective neuropsychological deficits. Objective deficits were reported, including poor selective and divided attention, slow information processing and vulnerability to distraction. In some studies, cognitive performance was inversely correlated with pain, exertion and fatigue. Performance validity testing demonstrated poor effort in only a minority of subjects, and patients with CFS showed a heightened perception of effort. DISCUSSION The cognitive profiles of FM, CFS and non-cognitive FND are similar to the proposed features of FCD, suggesting common mechanistic underpinnings. Similar findings have been reported in patients with mild traumatic brain injury and whiplash. We hypothesise that pain, fatigue and excessive interoceptive monitoring produce a decrease in externally directed attention. This increases susceptibility to distraction and slows information processing, interfering with cognitive function, in particular multitasking. Routine cognitive processes are experienced as unduly effortful. This may reflect a switch from an automatic to a less efficient controlled or explicit cognitive mode, a mechanism that has also been proposed for impaired motor control in FND. These experiences might then be overinterpreted due to memory perfectionism and heightened self-monitoring of cognitive performance.
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Affiliation(s)
- Tiago Teodoro
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK.,Instituto de Medicina Molecular Faculdade de Medicina, Universidade de Lisboa & Serviço de Neurologia Hospital de Santa Maria, Lisboa, Portugal
| | - Mark J Edwards
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jeremy D Isaacs
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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50
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Pidal-Miranda M, González-Villar AJ, Carrillo-de-la-Peña MT, Andrade E, Rodríguez-Salgado D. Broad cognitive complaints but subtle objective working memory impairment in fibromyalgia patients. PeerJ 2018; 6:e5907. [PMID: 30498630 PMCID: PMC6252063 DOI: 10.7717/peerj.5907] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cognitive dysfunction in fibromyalgia (FM) encompasses objective cognitive difficulties, as measured in neuropsychological tests, and self-reported cognitive complaints. Although it has been suggested that FM patients display problems in working memory, the data are inconsistent, and the overall working memory status of the patients is unclear. It is also not clear whether the working memory problems are related to cognitive complaints or how the dyscognition is affected by the characteristic clinical symptoms of FM. METHODS To clarify these aspects, we explored the neuropsychological performance for different components of working memory and the subjective self-perception of cognitive status in a sample of 38 women with FM. They were compared with a matched group of 32 healthy women. RESULTS Our findings suggested that the FM patients do not differ from healthy controls in their overall working memory functioning. Only a poor performance was found in a single task of visuospatial working memory, mediated by the presence of depressive symptoms, fatigue and pain. The FM patients also displayed a higher level of perception of cognitive difficulties than healthy controls, and this difference was mediated by depression and fatigue. Furthermore, cognitive complaints in FM patients were only associated with a lower verbal WM capacity. DISCUSSION FM patients have a subtle specific impairment in their working memory functioning, as well as elevated concern about their cognitive status. These findings suggest a disconnection between neuropsychological performance and subjective complaints. In FM patients, clinical variables such as pain, fatigue, and depression play an important role in dyscognition, as assessed by both objective and subjective measures, and should be taken into account in future research.
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Affiliation(s)
- Marina Pidal-Miranda
- Department of Clinical Psychology and Psychobiology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Jacobo González-Villar
- Department of Clinical Psychology and Psychobiology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Elena Andrade
- Department of Social, Basic and Methodological Psychology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Dolores Rodríguez-Salgado
- Department of Clinical Psychology and Psychobiology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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